The other day, I was asked to participate in a project at work, and one of my colleagues mentioned I was a good choice because I brought the perspective of a surgeon to the situation. From the content and tone of the conversation, this was clearly meant as a compliment, but the statement had me thinking, “What does it mean to think like a surgeon?”

The first image to run through my head was the musician Weird Al Yankovic’s “Like a Surgeon,” the satire of Madonna’s “Like a Virgin.” This probably occurred because Weird Al is one of my 12-year-old son’s favorite musicians (I’ve been forced to listen to literally every Weird Al song while my son guffaws in hilarity), and I’m an immature product of the 1980s. Despite the tongue-in-cheek depiction of surgeons as dumb, malpractice adverse, knife-happy, careless lunatics, there may in fact be something to learn from how surgeons think. For those of you interested in a more cerebral exploration than what I’m likely to undertake below, I highly recommend Dr Jerome Groopman’s fascinating book, How Doctors Think. Although it’s not exclusively about surgeons, I guarantee you’ll learn something new from reading this book.

I’ll say at the outset that although a major part of my personal podiatric identity is as a foot and ankle surgeon, I never felt this was somehow separate from my identity as a podiatric medical doctor or even as something apart from me as a person in general. This, then, is an exercise in self-exploration as much (or more than) it is an explanation of how “we surgeons” think. I imagine those of you reading this who participate in the surgical side of human medicine may agree or disagree with my observations below.

So…how do surgeons think?

Conceptual Integrity - This term, coined by the computer programmer Frederick Brooks in his 1995 book, The Mythical Man-Month: Essays on Software Engineering, describes the concept of having both a detailed and broad perspective of a problem. A surgeon must have this viewpoint during a surgery working with the OR team. The surgeon is generally the only person that has a full and complete understanding of all the steps necessary to complete a procedure. Each of the other members of the team has their important roles, but doesn’t know all the details and the order necessary to successfully complete a case. Despite the importance of the team, someone needs to have the vision to carry the job from beginning to successful end. In the past, this conceptual integrity existed as authoritarianism with surgeons throwing knives and treating staff poorly. Luckily this is a past phenomenon, and most surgeons today understand the importance of appropriately leading a team.

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“The surgeon is the only one in the OR who needs to have the vision to conduct the procedure from beginning to successful end”

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Have a Plan B - Every good surgeon knows that sometimes a procedure doesn’t go as planned. Whether it’s a failed instrument, missing device, or patient complication like altered anatomy, something is bound to go wrong at some point. This is why having a backup plan (and a backup for the backup) is pivotal to the successful completion of a procedure, as it is in life.

Detail Focus - The devil truly is in the details. In my experience, this is the difference between a well-executed procedure and a difficult one. Proper patient positioning, appropriate incision placement, meticulous dissection, a full appreciation of the pathoanatomy. These, among an almost infinite number of other details, makes the difference between success and hardship.

Thoughtful Preparation - Although many procedures can be completed at the spur of the moment (this happens during some trauma situations, for example), it’s always better to take the time to think through a procedure from start to finish before it happens. Ordering appropriate imaging before a fracture repair, for instance, assists the surgeon with understanding the full nature of the injury about to be fixed. Similarly, preparing beforehand with the correct fixation materials is integral to a successful reconstruction.

Confidence - This is going to sound like a spin on the critique that surgeons think they’re God and are excessively arrogant. I’ll agree that it takes a certain arrogance to open up the body of another human, fixing their problem, and getting out. This isn’t arrogance; it’s confidence. Surgeons spend years training to be the best they can be. They then continue to hone their skills over years, learning new techniques and modifying old ones. This breeds confidence. If you don’t believe me, watch two different surgeries: one with a confident surgeon and one with a timid surgeon. Operating room teams hate timid surgeons for the reason that their leader appears unconfident and indecisive. Do you want to go into war with Charlie Brown or Rambo?

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“A surgeon must appear confident to the OR team. Do you want to go into war with Charlie Brown
or Rambo? ”

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Obviously, as in anything else, surgeons are nothing more than people who are heavily trained to do a specific job. However, this training leads to a certain perspective, which can be highly beneficial applied outside of the operating room. If you’re a surgeon, I hope you realize that your skills from the OR are also applicable throughout life. If you’re not one, don’t be afraid to channel your inner surgeon. These universal skills are good for all of us to master.